Provider Demographics
NPI:1184015786
Name:BAKER, BETH
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 GRANDVIEW AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1729
Mailing Address - Country:US
Mailing Address - Phone:717-988-8200
Mailing Address - Fax:717-221-5644
Practice Address - Street 1:225 GRANDVIEW AVE STE 303
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-1729
Practice Address - Country:US
Practice Address - Phone:717-988-8200
Practice Address - Fax:717-221-5644
Is Sole Proprietor?:No
Enumeration Date:2015-02-18
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000238133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered